Filling equipment questionnaire

1. Explosion-Proof yes , Class / Division:
no

2. Component(s) Type of material
Viscosity:
Specific gravity:
Foaming: yes no
Air-bubbles: yes no
Granulates: yes no
Additional information:

3. Storage of the component(s) Size of the storage tank:
Distance between storage tank - filling installation:
Pump / filter present or required :

In case you require a quotation for the storage tank and piping, please add more information about the building and available space.

4. Filling procedure Type of packaging (bottle, tin, can, etc):
Filling volumes:
Dimensions (ø x h):
Size of the fill opening:
Number of fillings per minute:
Subdivision of different filling volumes (.. % - .. ltr):
Number of different products:
Smallest quantity:
Largest quantity:
Required accuracy (in gr):
Additional information:

5. Closing procedure How to close (pressing lid, pushing cap, screw cap, etc.):
Closing procedure (manual or automatic lid placing, manual or automatic lid closing.):

6. Specific features Container feed conveyor: yes no
Container discharge conveyor: yes no

7. Available utilities Air pressure:
Electricity:

8. Additional information Type of solvent:
Stainless steel quality:
Filter:
Available space:

Contact Information Company name: *
Address: *
City: *
Country: *
Phone: *
Fax:
E-mail: *
Contact person: *
Profession:
Additional information:

Fields marked * are required for submission

Gemini Techniek B.V.
Metaalstraat 22
7483 PD Haaksbergen
the Netherlands

Tel.: +(31) 53 428 3000
Fax: +(31) 53 428 3409